01
Demographics & contacts
Legal name, DOB, address, pronouns, emergency contact, HIPAA release.
New patient registration
Your registration packet, in one careful pass.
Once your intake has been accepted, this packet gathers everything we need to safely start treatment — demographics, insurance, current medications, your care team, and program-specific consents. Most patients finish in 20–30 minutes; your progress saves as you go.
Time
20–30 min
Security
HIPAA encrypted
Saves
Auto, resumable
Reviewed by
Your clinician
What we collect
Five short sections. Nothing redundant.
02
Insurance + ID
Primary and secondary insurance with photos of the front and back of each card.
03
Care team & meds
PCP, psychiatrist, therapist, pharmacy. Current medications, allergies, diagnoses.
04
Consents
Per-program consent, Terms, Privacy, Telehealth, and AI Documentation consent.
05
Practice agreements
Lab monitoring schedule and random drug screen policy.
Practice agreements
What we ask of every ketamine and Spravato patient
Random drug screens
Random urine drug screens are part of every ketamine and Spravato program at Trellis Pathway. Refusal pauses treatment. Findings are reviewed clinically, not punitively.
Lab monitoring
Baseline labs are required before your first dose: CBC, comprehensive metabolic panel (CMP), liver function tests (LFTs), TSH, lipid panel, and urine pregnancy testing when applicable. Maintenance patients repeat metabolic labs every 6–12 months and urinalysis every 6 months.
AI-assisted documentation (optional)
With your consent, we use AI-assisted ambient documentation to draft visit notes from your in-clinic and telehealth sessions. Recordings are processed within our HIPAA business associates' systems, used only to generate your chart note, and deleted within 30 days. You may opt out at any time without affecting your care.
Before you start
Currently in mental health treatment? Grab the authorization letter first.
If you are actively under the care of another psychiatrist, PMHNP, PA, or prescribing therapist, your referring provider must complete a short authorization letter and attach your current medication list. Download a template now so you can hand it to your provider and have it ready to upload inside the registration packet. New-patient leads cannot be accepted without it when current treatment is disclosed.
What your provider must include
- Full name and credentials (MD / DO / NP / PA)
- Active medical license number and state
- NPI number (and DEA if controlled substances are prescribed)
- Office phone, fax, and email
- Signed attestation authorizing Trellis Pathway to evaluate and treat you
- Attached current medication list (name, dose, frequency, prescriber)
You'll upload the signed letter and medication list inside the registration packet (Section 6.5). Your provider may also fax them — email admin@trellispathway.com for the secure fax number.
By treatment
Monitoring schedules by program
You'll choose which program(s) you've been recommended for during the packet. Each one has its own consent with the same plain-language detail below.
Spravato® (esketamine nasal spray)
Setting: In-clinic only — FDA REMS program
Schedule: Induction: twice weekly for 4 weeks. Maintenance: weekly for weeks 5–8, then every 1–2 weeks ongoing.
Monitoring: Each visit is a minimum 2-hour monitored session: dose, then 2 hours of vital signs, sedation, and dissociation checks before discharge.
Transportation: You may NOT drive, work, or operate machinery for the rest of the day after dosing. A licensed adult must drive you home.
Labs: Baseline CBC, CMP, LFTs, TSH, lipid panel, urine pregnancy (if applicable). Repeat metabolic panel every 6–12 months.
Drug screens: Baseline urine drug screen. Random screens may be requested at any treatment visit.
Requirements to start
- Confirmed treatment-resistant depression diagnosis from your prescriber
- REMS enrollment with both you and our clinic
- Reliable transportation home after every session
- Nothing to eat for 2 hours and no fluids for 30 minutes before dosing
Key risks you'll acknowledge
- Dissociation, sedation, dizziness, nausea
- Transient blood-pressure elevation
- Rare suicidal thoughts (REMS-tracked)
- Potential for misuse — controlled substance
IV Ketamine
Setting: In-clinic only — off-label for depression / anxiety / chronic pain
Schedule: Standard induction: 6 infusions over 2–3 weeks (typically Mon/Wed/Fri or twice weekly). Maintenance individualized after response review.
Monitoring: ~40-minute infusion under continuous BP, HR, and SpO₂ monitoring, then 30–60 minutes of recovery before discharge.
Transportation: You may NOT drive or operate machinery the rest of the day. Bring a driver — no Uber/taxi without an adult companion.
Labs: Baseline CBC, CMP, LFTs, TSH, urine pregnancy (if applicable). Repeat metabolic panel every 6–12 months. Periodic urinalysis with maintenance dosing.
Drug screens: Baseline urine drug screen. Random screens at any visit. Active stimulant or opioid use may pause treatment.
Requirements to start
- Established psychiatric or pain diagnosis warranting ketamine
- Adult driver / companion at every visit
- Fasting from solids 4 hours before infusion
- Stable cardiovascular history (uncontrolled HTN must be addressed first)
Key risks you'll acknowledge
- Dissociation, vivid sensory experiences
- Transient blood-pressure / heart-rate elevation
- Nausea, headache
- Long-term: bladder irritation (cystitis) with frequent dosing
At-Home Oral Ketamine
Setting: Home setting with required peer monitor and clinic oversight
Schedule: Typically 1–2 supervised home doses per week during induction, tapering to maintenance per your prescriber's plan.
Monitoring: Pre-session safety screen + peer monitor present for the full 2-hour observation window. BP at baseline, 40 min, 2 hr. Patient log + peer co-sign submitted via portal after every dose.
Transportation: Stay home for the full session. No driving, work, childcare alone, or operating machinery until the next morning.
Labs: Baseline CBC, CMP, LFTs, TSH, urine pregnancy (if applicable). Repeat metabolic and UA every 6 months with maintenance dosing.
Drug screens: Baseline UDS plus random screens. Diversion concerns or positive screens for non-prescribed controlled substances pause the program.
Requirements to start
- Successful in-clinic induction or prior ketamine experience documented by prescriber
- Verified peer monitor (18+, trained, no active substance-use disorder) — they will be vetted separately
- Quiet, safe home environment — no firearms accessible during session
- Lockbox for medication between doses
- Reliable internet / phone for portal session log + emergency contact
Key risks you'll acknowledge
- Dissociation, sedation, ataxia
- Falls risk — peer monitor must remain at arm's length
- Misuse / diversion (controlled substance)
- Bladder symptoms with frequent dosing